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Comparison of the Quality of Recovery-15 score in patients undergoing oncoplastic breast-conserving surgery under monitored anesthesia care versus general anesthesia: a prospective quality improvement study

Comparaison du score de Qualité de la récupération 15 chez les patientes subissant une chirurgie mammaire conservatrice oncoplastique sous sédation procédurale par rapport à une anesthésie générale : une étude prospective d’amélioration de la qualité

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Abstract

Purpose

Whether changing the institutional practice from general anesthesia (GA) to monitored anesthesia care (MAC) affects postoperative quality of recovery for oncoplastic breast-conserving surgery (BCS) is currently unknown. We designed this quasi-experimental study to evaluate a quality improvement (QI) initiative instituted in Edmonton, AB, Canada.

Methods

We chose a prospective controlled cohort study design for this QI study, where patients underwent oncoplastic BCS under MAC in one hospital and BCS under GA at another hospital (control). A total of 125 patients undergoing surgery between May 2021 and February 2022 were enrolled. Exclusion criteria were male sex, total mastectomy, or age under 18. All other patients were included. The primary outcome was the change in Quality of Recovery-15 score at 24 hr compared with a preoperative baseline. Secondary outcomes included intra- and postoperative time profiles, perioperative analgesic and antiemetic use and length of hospital stay. Statistical analysis included a propensity score analysis to account for confounding variables.

Results

Sixty-four patients received GA and 61 MAC. No enrolled patients were lost to follow up but two were excluded secondarily. No patients receiving MAC needed conversion to GA or unplanned airway management. Monitored anesthesia care was associated with superior outcomes for the primary outcome (β/SE[β], 3.31; 99.5% confidence interval, 0.45 to 6.17; P = 0.001) and most secondary outcomes, when accounting for confounding factors.

Conclusions

A care transformation initiative for patients undergoing oncoplastic BCS under MAC was associated with a higher quality recovery profile and shorter length of stay without any increase in perioperative or postoperative adverse events.

Résumé

Objectif

On ignore actuellement si le fait de modifier la pratique institutionnelle de l’anesthésie générale (AG) à la sédation procédurale (monitored anesthesia care) affecte la qualité de la récupération postopératoire en cas de chirurgie mammaire conservatrice oncoplastique. Nous avons conçu cette étude quasi expérimentale pour évaluer une initiative d’amélioration de la qualité mise en place à Edmonton, Alberta, Canada.

Méthode

Nous avons choisi une méthodologie d’étude de cohorte prospective contrôlée pour cette étude d’amélioration de la qualité, dans laquelle des patientes ont bénéficié d’une chirurgie mammaire conservatrice oncoplastique sous sédation procédurale dans un hôpital et de la même chirurgie sous anesthésie générale dans un autre hôpital (groupe témoin). Au total, 125 patientes bénéficiant d’une intervention chirurgicale entre mai 2021 et février 2022 ont été recrutées. Les critères d’exclusion étaient le sexe masculin, la mastectomie totale ou un âge de moins de 18 ans. Toutes les autres personnes ont été incluses. Le critère d’évaluation principal était la variation du score de Qualité de la récupération 15 à 24 heures par rapport aux valeurs initiales préopératoires. Les critères d’évaluation secondaires comprenaient les profils temporels per- et postopératoires, l’utilisation périopératoire d’analgésiques et d’antiémétiques et la durée du séjour à l’hôpital. L’analyse statistique comprenait une analyse par score de propension pour tenir compte des variables de confusion.

Résultats

Soixante-quatre patientes ont reçu une anesthésie générale et 61 une sédation procédurale. Aucune patiente recrutée n’a été perdue au suivi, mais deux ont été exclues secondairement. Aucune patiente recevant une sédation procédurale n’a eu besoin d’une conversion en anesthésie générale ou d’une prise en charge non planifiée des voies aériennes. La sédation procédurale était associée à des issues supérieures pour le critère d’évaluation principal (β/ET[β], 3,31; intervalle de confiance à 99,5 %, 0,45 à 6,17; P = 0,001) et la plupart des critères d’évaluation secondaires, en tenant compte des facteurs de confusion.

Conclusion

Une initiative de transformation des soins pour les patientes bénéficiant d’une chirurgie mammaire conservatrice oncoplastique sous sédation procédurale a été associée à un profil de récupération de meilleure qualité et à une durée de séjour plus courte sans augmentation des événements indésirables périopératoires ou postopératoires.

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Author contributions

Azadeh N. Rajaee and David W. Olson contributed to conception and design of the study. Deborah Freelove contributed to the acquisition of data. Nirudika Velupillai contributed to the analysis of data. Karen Buro contributed to the conception and design of the study and to the data analysis. Rakesh V. Sondekoppam and Timur J.-P. Özelsel contributed to study conception and design; acquisition, analysis, and interpretation of data; and drafting the manuscript.

Acknowledgements

We acknowledge the help of Professor Jan-Peter Jantzen in the editing of the manuscript. Further, we acknowledge the help of Dana Deverdenne in the coordination of data collection. Finally, we acknowledge the many medical staff who helped in creating a new standard of anesthesia, as well as our patients, who willingly helped us by answering the QoR-15 questionnaire.

Disclosures

All authors declare no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Funding statement

The work in this manuscript was not funded externally.

Data availability

The metadata for this manuscript is available upon reasonable request from the lead author.

Editorial responsibility

This submission was handled by Dr. Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Azadeh N. Rajaee MD & David W. Olson MD

  2. Faculty of Nursing, University of Alberta, Edmonton, AB, Canada

    Deborah Freelove RN

  3. Department of Mathematics and Statistics, MacEwan University, Edmonton, AB, Canada

    Nirudika Velupillai BSc & Karen Buro PhD

  4. Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Rakesh V. Sondekoppam MD

  5. Department of Anesthesiology & Pain Medicine, University of Alberta, 2-150 Clinical Sciences Building, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada

    Timur J.-P. Özelsel MD, DESA

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  1. Azadeh N. Rajaee MD
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Correspondence to Timur J.-P. Özelsel MD, DESA.

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Rajaee, A.N., Olson, D.W., Freelove, D. et al. Comparison of the Quality of Recovery-15 score in patients undergoing oncoplastic breast-conserving surgery under monitored anesthesia care versus general anesthesia: a prospective quality improvement study. Can J Anesth/J Can Anesth 70, 1928–1938 (2023). https://doi.org/10.1007/s12630-023-02567-3

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